Nursing Elites

1. A client with a chest tube connected to a closed drainage system needs to be transported to the x-ray department. Which of the following actions should the nurse take?

• A. Clamp the chest tube prior to transferring the client to a wheelchair.
• B. Disconnect the chest tube from the drainage system during transport.
• C. Keep the drainage system below the level of the client's chest at all times.
• D. Empty the collection chamber prior to transport.

Correct answer: C

Rationale: When transporting a client with a chest tube connected to a closed drainage system, it is crucial to keep the drainage system below the level of the client's chest at all times. This positioning prevents the backflow of drainage into the client's chest, reducing the risk of complications. Clamping the chest tube, disconnecting it from the drainage system, or emptying the collection chamber are incorrect actions and can potentially harm the client or lead to complications.

2. What information should be included as effective for preventing chronic bronchitis in a community presentation?

• A. Maintenance of ideal weight
• B. Annual influenza immunization
• C. Smoking cessation
• D. Regular moderate exercise

Correct answer: C

Rationale: Chronic bronchitis is often linked to smoking. Smoking cessation is the most effective preventive measure to reduce the risk of developing chronic bronchitis. Smoking damages the airways and leads to inflammation, making individuals more susceptible to chronic bronchitis. While maintaining an ideal weight, getting an annual influenza vaccine, and engaging in regular moderate exercise are beneficial for overall health, the most crucial intervention to prevent chronic bronchitis is quitting smoking.

3. A client who received benzocaine spray before a recent bronchoscopy presents with continuous cyanosis despite oxygen therapy. What action should the nurse take next?

• A. Administer albuterol treatment.
• B. Notify Rapid Response Team.
• C. Assess the client's peripheral pulses.
• D. Obtain blood and sputum cultures.

Correct answer: B

Rationale: Cyanosis unresponsive to oxygen therapy suggests methemoglobinemia, an adverse effect of benzocaine spray. Methemoglobinemia can lead to death if not managed promptly. The nurse should notify the Rapid Response Team to provide immediate advanced care. Administering albuterol would not address the underlying cause of cyanosis. Assessing peripheral pulses and obtaining cultures are not the priority as they do not directly address the urgent need to manage methemoglobinemia.

4. When assessing a client with a pneumothorax and a chest tube, which finding should the nurse notify the provider about?

• A. Movement of the trachea toward the unaffected side
• B. Bubbling of the water in the water seal chamber with exhalation
• C. Crepitus in the area above and surrounding the insertion site
• D. Eyelets not visible

Correct answer: A

Rationale: The movement of the trachea toward the unaffected side is concerning as it can indicate a tension pneumothorax, a life-threatening emergency that requires immediate intervention. The trachea should be midline, so any deviation should be reported promptly to the provider for further evaluation and intervention.

5. While caring for a client receiving positive-pressure mechanical ventilation, which intervention should the nurse NOT implement to prevent complications?

• A. Elevate the head of the bed to at least 30°.
• B. Verify the prescribed ventilator settings daily.
• C. Administer pantoprazole as prescribed.
• D. Reposition the endotracheal tube to the opposite side of the mouth daily.

Correct answer: D

Rationale: Repositioning the endotracheal tube to the opposite side of the mouth daily is not a standard practice and can increase the risk of complications, such as accidental extubation or damage to the airway. The endotracheal tube should remain in the initial correct position to ensure proper ventilation and prevent harm to the client. Elevating the head of the bed, verifying ventilator settings, and administering pantoprazole as prescribed are all appropriate interventions to prevent complications in a client receiving positive-pressure mechanical ventilation.

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